Department of Anesthesiology, University Hospital of Gran Canaria Dr. Negrín, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Department of General and Digestive Surgery, University Hospital of Gran Canaria Dr. Negrín, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Geriatr Gerontol Int. 2017 Dec;17(12):2389-2395. doi: 10.1111/ggi.13081. Epub 2017 Jul 4.
In countries with longer life expectancies, the nonagenarian population is increasing. Therefore, there is greater demand for healthcare, including surgical procedures. The aim of the present study was to determine the outcomes of surgery carried out on nonagenarians in terms of long-term survival after the procedure.
We carried out a cross-longitudinal study on a cohort of 159 nonagenarian patients, who underwent a non-cardiac, non-traumatic surgical procedure in our institution between January 1999 and December 2011. The following variables were recorded: sociodemographic characteristics, American Society of Anesthesiologists score, Charlson Comorbidity Index, surgical site, postoperative complications, operative mortality and long-term survival. The output variable was long-term survival.
Of the 159 patients,99 women (62%) and 60 men (38%), with a mean age of 91.8 years (SD ± 2.0 years), 44 cases were operations for malignant disorders (28%), 117 cases (74%) under emergency conditions and 42 cases (26%) were elective treatments. The operative mortality was 29%, 4.8% for elective surgery and 37.6% for emergency surgery (P < 0.001). The postoperative complication rate, including death, was 60%. The probability of survival at 1, 3, and 5 years was 59.6%, 35.8% and 24.1%, respectively. In multivariate analysis, American Society of Anesthesiologists score (HR 2.07, 95% CI 1.58-2.72), emergency surgery (HR 1.64, 95% CI 1.05-2.57) and postoperative medical complications (HR 2.58, 95% CI 1.73-3.85) were independently related to 5-year survival.
These findings support the perioperative safety of elective general surgery in nonagenarian patients. In selected nonagenarian patients with no cognitive impairment, surgery must not be denied. These data might be useful for surgical decision-making or informed consent for nonagerians. Geriatr Gerontol Int 2017; 17: 2389-2395.
在预期寿命较长的国家，90 岁以上人口数量不断增加。因此，对医疗保健的需求也在增加，包括手术。本研究旨在确定在我院接受非心脏、非创伤性手术的 159 例 90 岁以上患者的手术结果，即术后的长期生存情况。
我们对 1999 年 1 月至 2011 年 12 月期间在我院接受非心脏、非创伤性手术的 159 例 90 岁以上患者进行了一项跨纵向研究。记录了以下变量：社会人口学特征、美国麻醉医师协会评分、Charlson 合并症指数、手术部位、术后并发症、手术死亡率和长期生存情况。输出变量为长期生存情况。
159 例患者中，女性 99 例（62%），男性 60 例（38%），平均年龄为 91.8±2.0 岁，44 例（28%）为恶性疾病手术，117 例（74%）为急症手术，42 例（26%）为择期手术。手术死亡率为 29%，择期手术为 4.8%，急症手术为 37.6%（P<0.001）。术后并发症发生率（包括死亡）为 60%。1、3、5 年的生存率分别为 59.6%、35.8%和 24.1%。多变量分析显示，美国麻醉医师协会评分（HR 2.07，95%CI 1.58-2.72）、急症手术（HR 1.64，95%CI 1.05-2.57）和术后内科并发症（HR 2.58，95%CI 1.73-3.85）与 5 年生存率独立相关。
这些发现支持对 90 岁以上择期行普通外科手术患者的围手术期安全性。在无认知障碍的选择病例中，不应拒绝手术。这些数据可能对 90 岁以上人群的手术决策或知情同意有用。
